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Aspergillus and Endobronchial Abnormalities in Lung Transplant Recipients^*

^* From the Inova Transplant Center (Drs. Nathan, Schmidt, and Burton), Inova Fairfax Hospital, Falls Church, VA; and the Pulmonary & Critical Care Medicine Service (Dr. Shorr), Department of Medicine, Walter Reed Army Medical Center, Washington, DC.

Correspondence to: Steven D. Nathan, MD, FCCP, The Inova Transplant Center, Inova Fairfax Hospital, 3300 Gallows Rd, Falls Church, VA 22042-3300; e-mail: steven.nathan{at}inova.com

Study objective: To determine the relationship between aspergillus recovery from the airways of lung transplant recipients and the development of endobronchial abnormalities.

Design: Retrospective case series.

Setting: Tertiary-care hospital.

Patients: All patients who underwent lung transplantation between December 1991 and June 1999.

Measurements and results: The study cohort included 38 patients. The primary end point was the bronchoscopic identification of an endobronchial abnormality. Aspergillus was isolated from the lungs of nine patients (23.7%). Most of these isolates occurred early after transplantation (mean, 8 weeks). Endobronchial abnormalities arose in seven of the patients (18.4%) and manifested as either exuberant granulation tissue or stricture formation. Six of the 9 (66.6%) patients with aspergillus developed airway lesions, compared to 1 of the 29 patients (3.4%) without aspergillus (p = 0.0002). Endobronchial abnormalities were 19.3 times more likely to occur in patients in whom aspergillus had previously been isolated. As a screening test for the subsequent diagnosis of an airway complication, the recovery of aspergillus had a sensitivity and specificity of 85.7% and 90.3%, respectively. These aspergillus-related endobronchial abnormalities were clinically relevant as evidenced by a mean increase of 25.9% in the FEV₁ after bronchoscopic intervention.

Conclusion: The early isolation of aspergillus from the airways of lung transplant recipients identifies patients at increased risk for the development of clinically significant endobronchial abnormalities.

Key Words: anastamosis, surgical • aspergillus • bronchi • bronchoscopy • lung transplantation • respiratory function tests • surgical wound infection

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